LECTURE 11b. Treating Recent Trauma. RE - Recent Events. Recent Events. Francine Shapiro. (Which to choose? You be the Judge)

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1 LECTURE 11b Recent Events Treating Recent Trauma (Which to choose? You be the Judge) RE R-TEP A-TIP ERP RE (F. Shapiro): Standard EMDR R-TEP (E. Shapiro / Brurit Laub) -EMD, EMDr, EMDR A-TIP (Kiessling): EMD ERP (G Quinn): ERP RE - Recent Events Francine Shapiro AIP - Incident is fractionated Client is unable to work through an experience Environment- it is over (not on-going)l Eye Movements (Research) Images fade, emotions decrease, linkages occur, insight, adaptive learning Applications Recent Trauma and it is over Client has the ability to process (past, present, future)

2 Case Conceptualization Phase 1: Telling the story Have the client tell their story Look for spikes during the narrative With each spike identify the irrational belief (NC) Phase 2 - Stabilization Calm Inner Space or other? Processing (Specific to global processing) Phase 3:Accessing and Activating Worst, then Chronological Each Target may (will) have a different NC/PC structure Phase 4: Fractionated to ConsolidatedDesensitization 1. Desensitize worst target: SUD>0 (ecological) 2.Installation PC for that target: VoC<7 (ecological) no body scan (yet) 3.Repeat Phases 1 & 2 for each target - repeat narrative chronologically until totally consolidated (no more disturbing aspects: SUD=0) Phase 5: Global Installation As you think of the entire experience, what adaptive belief have you realized (PC)?-----Install PC (VoC=7) Neutral or Clear Phase 8: Re-evaluation Checking the work Present Triggers Three-pronged Processing Present Triggers Clear out any additional present triggers 1.Run Future Templates on all present triggers 2.?Past Does the Recent Event link to the Past?

3 R-TEP: RECENT TRAUMATIC EPISODIC PROCEDURES Elan Shapiro & Brurit Laub AIP - Client is unable to work through the traumatic experience Bilateral Stimulation Tapping Eye Movements Clinical Interventions (Processing Continuum: EMD, EMDr, EMDR) Target processing with options to do more or less Applications Resent Trauma within an on-going traumatic environment Client ability/inability to process (past, present, future) Case Conceptualization Phase 1: Telling the story Constant BLS - tapping/watching tapping Calming, initial grounding during the telling story process Phase 2 - Stabilization Calm Inner Space or other Pre-processing Resource(Laub) Processing Phase 3:Accessing and Activating Goggle Search for worst (repeat Goggle Search to identify and process the next worst aspect***) Phase 4: Desensitization Clinical judgment regarding initial processing modality (EMD, EMDr, EMDR) Ballon in or out as necessary*** EMD, EMDr, EMDR as is clinically appropriate Phase 5: Installation Standard Clinical Judgment Reevaluation Future Triggers *** Modifications to the Recent Events Protocols

4 A-TIP: ACUTE TRAUMATIC INCIDENT PROCESSING (Experimental: Roy Kiessling) Application Settings Disasters Crisis setting Client is out of the shock of the trauma Little if any time has passed since trauma Environment may still be traumatic 1. Time/Setting limited 1. Workman s Compensation Referral Client s issue is pending-needing immediate processing Future Triggers A-TIP Procedures Case Conceptualization Phase 1: Walk through what happened Slow tapping or heals going up and down while giving narrative (modified from E. Shapiro s R-TEP) Phase 2: Stabilization/Affect Management Breathing Container Mindfulness Inner Calm Space Do? Say? Processing Phase 3: Access & Activate - Standard Phase 4: Restricted Processing Process the incident using EMD procedures SUD > 0 Ecological Phase 5: Installation VoC <7 Ecological 1. Use clinical judgment Phase 8 Reevaluation Future Triggers Do? Say?

5 EMERGENCY RESPONSE PROCEDURES ERP (Emergency Room Procedures: Gary Quinn) AIP - Client is frozen in the Traumatic experience Usually no history Usually no preparation other then explanation of BLS (if that) Usually no accessing and activating With permission, Immediately begin Continuous EMs CONTINUOUS (EM s) Client nurtures, supports, reframes constantly saying: It s over The incident...is over, You are here, You are safe now, That incident is in the past, Follow my fingers, Notice what you are hands are touching, Place your feet firmly on the ground Salivate Have a drink of water SUMMATION: Recent Trauma BLS Interventions ERP A-TIP R-TEP RE But... if the trauma had a pre-existing condition? EMDR Additional interventions may be necessary to accomplish total treatment effects: EMDR from a Belief Schema Perspective